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APPLICATION FOR EMPLOYMENT - IN CONFIDENCE

The completion of this application form is an integral part of our recruitment process. Please do not substitute your CV for this document. Please complete this form in BLACK ink or type. We suggest that you read the accompanying guidelines before you start to complete this form

POST APPLIED FOR

INTERNAL USE ONLY JOB REFERENCE & CANDIDATE NUMBER:

PERSONAL DETAILS – PART A

Preferred Title (Mr Mrs Miss Ms Other (specify)First Name(s)Last name/Family NameAddress

Postcode

Telephone Numbers inc. STD Code

Home

Mobile

Work

Email AddressWe may need to contact you during the day, please indicate which is the telephone number you would prefer us to call you on.

ASYLUM & IMMIGRATION ACT 1996

National Insurance No

Are you eligible to live and work in the UK in accordance with the Asylum & Immigration Act 1996?Do you need a work permit?

If your application is successful you will be required to bring proof of eligibility to work in the UK to your interview.

West Anglia Crossroads Caring for Carers (known as Carers Trust Cambridgeshire) is a company limited by guarantee.Registered Charity No. 1091522 A company limited by guarantee Registered in England No. 4379948/tt/file_convert/5a74d2467f8b9ad22a8c1c65/document.docx

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REHABILITATION OF OFFENDERS ACT

Because of the nature of the work for which you are applying, you must provide information about any criminal record. This includes convictions, cautions, reprimands and final warnings. Our power to require this lies in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 which removes the normal operation of the Act in relation to specific occupations, including the provision of Home Care Services. In the event of being employed in connection with this application, any failure to disclose such convictions could result in dismissal or disciplinary action.

If you have no convictions please write NONE _____________________

If you do have any previous or outstanding convictions, cautions, reprimands or final warnings, you will only be asked to supply details of the type of offence, date, sentence, fine etc. if you are invited for interview. Please see guidelines on completing the application form for further details.

DISCIPLINARY / GRIEVANCES

Have you been involved in any Disciplinary/Grievance procedures in the last two years or do you have any issues pending?

YES / NO


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REFERENCES

Please give names, addresses and telephone numbers of two people who can provide references for you. They should be your last two employers. If you aren’t currently in employment please see the enclosed guidelines on completing this form. Crossroads reserves the right to contact other previous employers. We do not approach referees until after interview.

Present EmployerNameJob TitleOrganisation

Address & Postcode

Telephone NumberEmail AddressHow is this referee known to you?

Do you wish to be contacted before we approach this referee? YES / NO

Previous Employer (Please indicate if this referee is not your previous employer)NameJob TitleOrganisation

Address & Postcode

Telephone NumberEmail AddressHow is this referee known to you?


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DO YOU DRIVE? YES / NO ______________________

DO YOU HAVE ACCESS TO A VEHICLE? YES / NO ______________________

DECLARATION

I declare that all the information I have given on this application form is true and accurate, to the best of my knowledge. Please note that if you give untrue or inaccurate information any employment contract may be invalidated and the employee subject to disciplinary action or dismissal.

Signed: Date:

If you downloaded your application from the internet please print it off and sign.

Section A will be detached from your application. All short listing will be carried out on a completely fair basis with Equal Opportunities Legislation and Policy.


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INTERNAL USE ONLY JOB REFERENCE & CANDIDATE NUMBER:

EDUCATION & WORK HISTORY - PART B

EDUCATION & QUALIFICATIONS

Please tell us about the school/college/university you attended, starting with the most recent.

Names of Schools / Colleges / Universities Attended since age 11

Qualifications gained / being sought – including grades

VOCATIONAL TRAINING

Please tell us of any other further education or courses you have completed either at your present or previous employer(s) that you think are relevant to this application. See Guidance Notes for more detail.

Course Title & Content Organisation that ran the training Date & duration of training


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VOLUNTARY WORK

Please give details of any voluntary work or community activity.

PROFESSIONAL QUALIFICATIONS & MEMBERSHIPS

Please list details of any professional qualifications or your current membership of any organisation(s) which are relevant to this job.

Name of Organisation Type of Membership

We may request evidence of your qualifications before making an appointment?

PRESENT / MOST RECENT EMPLOYMENT

Employer’s NameEmployer’s Address & Postcode

Your Job TitleSalary/Wages Other Benefits £ pw/pa

Date Employed FromDate of Leaving (or notice period required)Please give us a brief description of your duties (please continue on a separate sheet if necessary)Reason for leaving


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PAST EMPLOYMENT

Please give details of your entire work history; any gaps in your employment history must be accounted for.

EMPLOYERS NAME AND ADDRESS

DATES EMPLOYED FROM & TO

JOB TITLE & BRIEF DESCRIPTION OF DUTIES

REASON FOR LEAVING

If you need more space please continue on a separate sheet of paper.


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ABOUT YOU – PART C

Please use this space to tell us how your skills, experience and knowledge match those in the job description and person specification. To assist you completing this section please refer to the guidance notes.

Personal Profile – Please give a brief description of yourself and your strengths.

Please provide four key skills you have that make you suitable for this role.

1.

2.

3.

4.

Please provide examples in answer to the following questions to support your application.

When have you achieved something of high quality or value? Why have you chosen this particular example? How do you think this would support you in the above role?

Describe a time where you have had to use your initiative in solving a problem or an West Anglia Crossroads Caring for Carers (known as Carers Trust Cambridgeshire) is a company limited by guarantee.Registered Charity No. 1091522 A company limited by guarantee Registered in England No. 4379948/tt/file_convert/5a74d2467f8b9ad22a8c1c65/document.docx

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issue. What difficulties or barriers did you encounter? What was the outcome?

Tell us about a time where you have provided information to customers. How did you approach this? What difficulties did you encounter? What was the outcome?

Please return the completed application form to the address below:

Carers Trust Cambridgeshire4 The Meadow, Meadow Lane, St Ives,Cambridgeshire, PE27 4LGTel: 0845 241 0954 or 01480 499090

recruitment@carerstrustcambridgeshire.orgwww.carerstrustcambridgeshire.org


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EQUAL OPPORTUNITIES MONITORING

We are an equal opportunities employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment on the grounds of age, race, ethnic or national origin, disability, gender, religion, beliefs, sexual orientation, domestic circumstances, social and employment status, HIV status, gender reassignment, or political affiliation.

Our selection criteria and procedures are frequently reviewed to ensure that all individuals are selected, promoted and treated on the basis of their relative merits and abilities.

All employees are given equal opportunity and are encouraged to progress within the organisation.

The information on this form will be treated in confidence and will not be used as part of the selection process. This monitoring form will be separated from your application form on receipt and will not be seen by the recruitment manager.

We are committed to an ongoing programme of action to make this policy fully effective. To ensure that this policy is fully and fairly implemented and monitored, and for no other reason, would you please provide the following information:-

Post applied for:

Where did you see this post advertised?

Newspaper and DateJob CentreWebsite www.

Word of MouthReferred by a friend (please name the individual)

Other (please specify)


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GENDER

Male Female

ETHNIC ORIGINI would describe my ethnic origin and/or nationality as:-

White Mixed Asian or Asian British

Black or Black British

Chinese or other ethnic group

British White & Black Caribbean

Indian Caribbean

Chinese

Irish White & Black African

Pakistani African Other ethnic group - please specify below

Irish Traveller

White & Asian

Bangladeshi

Other Black

Other Other Other Asian

Nationality: ………………………………………………………………………………………..

AGE BAND: 16-24 25-29 30-34 35-39 40-4445-49 50-54 55-59 60-65 65+

DISABILITYThe Equality Act 2010 defines a person as having a disability if he/she has a physical or mental impairment which has a substantial and long term (more than 12 months) adverse effect on his/her ability to carry out normal day to day activities.

Do you have a disability as defined above? YES / NO


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